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JAMA Ophthalmology Clinical Challenge
April 2016

Acute Increase in Intraocular Pressure in a Patient With a Glaucoma Drainage Implant

Author Affiliations
  • 1Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
JAMA Ophthalmol. 2016;134(4):457-458. doi:10.1001/jamaophthalmol.2015.3642

A woman in her late 50s presented to the clinic with severe right eye pain and a headache for the past 2 days. Her ophthalmic history was significant for mixed-mechanism glaucoma due to uveitis and chronic angle closure with prior implantation of bilateral superotemporal Baerveldt drainage implants. Her intraocular pressure (IOP) was controlled with topical brinzolamide. In addition, she had Fuchs corneal dystrophy. A month earlier, she had undergone Baerveldt implant repositioning from the anterior chamber to the sulcus in the right eye in preparation for future Descemet stripping endothelial keratoplasty owing to severe corneal decompensation. At that time, visual acuity was counting fingers at 1 ft OD. She was discharged with therapy including topical steroids, antibiotics, and atropine sulfate. On the first postoperative visit, IOP was 14 mm Hg OD by Goldmann applanation. On postoperative day 11, IOP remained stable at 7 mm Hg OD by Goldmann applanation and topical atropine was discontinued. At presentation 3 weeks postoperatively, IOP was 30 mm Hg OD by Goldmann applanation. Her visual acuity worsened from counting fingers to hand motions. Slitlamp examination of the right eye revealed a superotemporal Baerveldt drainage implant with fluid over the plate. High-resolution ultrasonography was performed (Figure).

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